Characteristics and outcomes of gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices: A systematic review.

Authors

• Laura A Carlson
• Elizabeth J Maynes
• Jae Hwan Choi
• Andrew M Hallett
• Dylan P Horan
• Matthew P Weber
• Avijit K Deb
• Sinal Patel
• Louis E Samuels
• Rohinton J Morris
• John W Entwistle
• H Todd Massey
• Vakhtang Tchantchaleishvili

Publication/Presentation Date

11-1-2020

Abstract

Gastrointestinal bleeding (GIB) is a common adverse event after continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate patterns of GIB development and related outcomes in CF-LVAD recipients. An electronic search was performed to identify all articles related to GIB in the setting of CF-LVAD implantation. A total of 34 studies involving 1087 patients were pooled for analysis. Mean patient age was 60 years (95% CI 57-64) and 24% (95% CI 21-28%) were female. The mean time from CF-LVAD implantation to the first GIB was 54 days (95% CI 24-84) with 40% (95% CI 34-45%) of patients having multiple episodes of GIB. Anemia was present in 75% (95% CI 41-93%) and the most common etiology of bleeding was arteriovenous malformations (36% [95% CI 24-50%]). The mean duration of follow-up was 14.6 months (95% CI 6.9-22.3) during which the all-cause mortality rate was 21% (95% CI 12-36%) and the mortality rate from GIB was 4% (95% CI 2-9%). Thromboembolic events occurred in 32% (95% CI 22-44%) of patients with an ischemic stroke rate of 16% (95% CI 3-51%) and a pump thrombosis rate of 8% (95%CI 3-22%). Heart transplantation was performed in 31% (95% CI 18-47%) of patients, after which 0% (95% CI 0-10%) experienced recurrent GIB. GIB is a major source of morbidity among CF-LVAD recipients. While death due to GIB is rare, cessation of anticoagulation during treatment increases the risk of subsequent thrombotic events. Heart transplant in these patients appears to reliably resolve the risk of future GIB.

Volume

44

Issue

11

First Page

1150

Last Page

1161

ISSN

1525-1594

Published In/Presented At

Carlson, L. A., Maynes, E. J., Choi, J. H., Hallett, A. M., Horan, D. P., Weber, M. P., Deb, A. K., Patel, S., Samuels, L. E., Morris, R. J., Entwistle, J. W., Todd Massey, H., & Tchantchaleishvili, V. (2020). Characteristics and outcomes of gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices: A systematic review. Artificial organs, 44(11), 1150–1161. https://doi.org/10.1111/aor.13725

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

32416628

Department(s)

Administration and Leadership

Document Type

Article